Acute lung injury (ALI) is a severe form of pulmonary impairment affecting 200,000 people annually in the United States. Acute respiratory failure (ARF) is an even more common type of pulmonary dysfunction characterized by profound alterations in oxygenation and ventilation. Though advances in the care of these critically ill patients have occurred, further cultivation of patient-oriented investigators with an interest in ALI/ARF will be necessary to generate significant improvements in the outcomes of these patients. Mentoring is by far the most important and fulfilling component of my current academic position. I am completely committed to mentoring, inherently enjoy developing mutual visions of success with my trainees, and appreciate the opportunity to make a difference in their lives and careers. With the support of my present K24, I have already served as the primary mentor or co-mentor for 16 junior or mid-level investigators performing ALI/ARF patient-oriented research. A total of 88% (14/16) of them remain in academic medicine. In less than four years, these trainees have received 4 new grants in excess of $5,000,000 and have 4 more NIH grants under review or ready for resubmission. They have also authored 24 research articles, 9 review articles/editorials, 5 research articles presently under submission, and 29 ATS abstracts on which I am the senior or a co-author. Despite our productivity, several new programs are proposed in this competitive renewal that will further enhance my career development and the training for all of our present and future trainees. With the creation of our city-wide research network, we are well positioned to perform comparative effectiveness research (CER) studies. In order to properly lead these efforts, I will need to boost my skills in CER research. Our increasing number of mid-level investigators will require advanced training in mentoring and leadership skills in order to prepare them to become the next generation of ALI/ARF mentors. In addition, I will create new training opportunities for our more junior investigators and work to attract trainees from other multidisciplinary fields. In this renewal, we also propose two research studies that will lead to improvements in the care of our ALI/ARF patients. The first study will build upon our existing interest in peripheral neuromuscular dysfunction in ALI/ARF patients and determine the utility of simple bedside techniques for the diagnosis of swallowing dysfunction that is common and debilitating in our patients. In the second translational study, we will continue to explore the mechanisms by which alcohol alters the susceptibility to develop ALI and determine whether alcohol abuse alters the clearance of apoptotic inflammatory cells during the resolution phase of ALI through oxidant-dependent RhoA activation. With the support of this competitive renewal, I will be able to continue to develop our research program and ultimately establish ourselves as one of the premier ALI/ARF research groups in the United States.